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Onychomycosis - Fungal Infection of Nails, Its Patterns and Treatment

Written by
Dr. Suvash Sahu
and medically reviewed by iCliniq medical review team.

Published on Mar 08, 2017 and last reviewed on Oct 10, 2019   -  2 min read


Most of the patients in dermatological practice who present with nail infections, come with an expectation that it gets cured in the first visit itself. But, due to the slow growth of nail plate and deeper involvement of nail matrix, it requires treatment for longer duration. In this article, I have discussed about fungal infection of the nails.

Onychomycosis - Fungal Infection of Nails, Its Patterns and Treatment

Onychomycosis includes nail infections due to dermatophytes, non-dermatophytes and yeasts as well. Dermatophyte infection of the nail plate is known as tinea unguium. It occurs due to the same species that causes tinea pedis (fungal infection of the feet) and tinea manuum (fungal infection of the hand) and coexist with them, seldom occurring before puberty.

Patterns of Onychomycosis

There are three types of onychomycosis:

  1. Distal subungual onychomycosis (DSO).
  2. White subungual onychomycosis (WSO).
  3. Proximal subungual onychomycosis (PSO).

Distal subungual onychomycosis is the most common variety. It starts when dermatophytes invade the stratum corneum of the hyponychium (thickened portion of skin, underlying the free edge of the nail plate) and distal nail bed to later reach the ventral surface of the nail plate. Whitish or brownish discoloration of the free edge of the nail, subungual hyperkeratosis (thickened material below the nail plate) and even separation of the nail plate from the nail bed can occur.

White superficial onychomycosis involves dorsal part of toenails as white, opaque and sharply demarcated rough areas.

Proximal subungual onychomycosis is the least common type. It starts with fungal invasion of the proximal nail fold and may subsequently extend to the nail plate. It can be associated with HIV infection or AIDS (acquired immunodeficiency syndrome).

Certain Facts About Fungal Nail Disease


1. Topical Antifungal Agents:

Amorolfine 5% and Ciclopirox 8% nail lacquers have better penetration through the nail plate. It can be used alone or in combination with oral antifungal agents, depending on the number and severity of nail involvement.

2. Oral Antifungal Agents:

Griseofulvin, Fluconazole, Itraconazole and Terbinafine are used. The dosage differs in case of fingernails and toenails. In case of fingernail infection, Griseofulvin 500 mg once daily for six months or Fluconazole 150 mg per week for 3 months or Itraconazole 200 mg twice daily for a week for two months or Terbinafine 250 mg once daily for six weeks.

In case of toenail infection, Griseofulvin 500 mg once daily for 12 months or Fluconazole 150 mg per week for 6 months, Itraconazole 200 mg twice daily for a week for three months or Terbinafine 250 mg once daily for 12 weeks. Griseofulvin is no longer in vogue due to the problem of resistance.

To know more about onychomycosis, consult a fungal infection specialist online -->


Frequently Asked Questions


What Are the Treatment Options for Onychomycosis?

Treatment options for onychomycosis include:
1. Oral antifungal drugs like -
- Griseofulvin.
- Terbinafine.
- Itraconazole.
- Ketoconazole.
2. Medicated nail polish -
- Amorolfine 5%.
- Tioconazole 28%.
3. Creams.
4. Surgical nail removal.


What Causes Onychomycosis?

Several potential pathogens cause onychomycosis, which are:
- Dermatophytes.
- Yeast.
- Non-dermatophyte.


Is It Possible to Cure Onychomycosis?

Onychomycosis can take a long time to heal, and can take anywhere from two months to almost a year. It can be cured by chemical or surgical removal of the infected nail, systemic or topical drugs, pulse therapy, or a combination of them.


Can Onychomycosis Get Cured on Its Own?

Fungal nail infection, also called onychomycosis, does not get cured on its own. Treatment is always required. It generally starts at the tip of the nail and progresses downwards towards the root. And in people with diabetes, fungal toenail infections can cause ulceration and other complications, so medical attention is always required.


What Are the Natural Remedies for Nail Fungus?

The following natural remedies might help when applied topically over the infected nail.
- Hydrogen peroxide.
- Apple cider vinegar.
- Baking soda.
- Essential oils.
- Epsom salts.
- Ozonated oils.


Can Onychomycosis Spread to Other Body Parts?

Fungal nail infections can be passed from one infected nail to another due to direct or indirect contact. This infection can also spread to the surrounding skin and lead to athlete’s foot. It is also possible for the infection to spread to the bone and result in severe complications. The fungus from the infected toenail can also spread to the groin and private parts while wearing pants, resulting in jock itch.


How to Treat White Superficial Onychomycosis at Home?

White superficial onychomycosis (WSO) can be effectively treated at home with the help of vinegar. It is a safe and effective home remedy for WSO. The infected foot should be immersed for 20 minutes daily in a solution consisting of one part vinegar and two parts warm water. Vinegar has antifungal properties, and you will see improvement in about 2 to 3 weeks.


How Long Does It Take for Onychomycosis to Heal?

Onychomycosis takes about 12 weeks for toenails and 6 weeks for fingernails to heal when Terbinafine 250 mg is taken orally once daily. With Itraconazole 200 mg orally taken daily, it takes 3 months for toenails and 1 week for fingernails. When topical medicines like Ciclopirox, Efinaconazole, and Tavaborole are used, it can take up to 48 weeks.


How Does Onychomycosis Look?

Onychomycosis, otherwise called tinea unguium, is a fungal infection of the nail. The infected nail might look white, opaque, thickened, or brittle. The other symptoms include:
- White or yellow nail discoloration.
- Thickening of the nail.
- Separation of nails from the nail bed.
- Both toenails and fingernails can be affected, but toenails are the most commonly affected.


What Are the Types of Nail Fungus?

The four types of nail fungus are:
- Distal subungual infection.
- Proximal subungual infection.
- White superficial infection.
- Candida infection of the nail.


How to Cure Onychomycosis Permanently?

Onychomycosis can be cured permanently with the help of antifungals. The examples include:
- Terbinafine 250 mg.
- Itraconazole 200 mg.
- Ciclopirox.
- Efinaconazole.
- Tavaborole.


Can Nail Fungus Get Killed by Vinegar?

Vinegar can kill various microorganisms like viruses, bacteria, and yeast. It has antimicrobial property to treat ear infection, warts, and nail fungus. Soaking the infected foot in vinegar is the best treatment for nail fungus.

Last reviewed at:
10 Oct 2019  -  2 min read




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